The Reality and Policy Implications of Falls Prevention: Personal Reflections
What home and/or community strategies or modifications are most important to reduce the risk of falling and how can policymakers encourage their widespread adoption? View the full forum.
By Fernando Torres-Gil
Falling down can be viewed as a fact of life. We all face slips, accidents, sports injuries and simply being uncoordinated and “klutzy.” And for most of us, this is simply embarrassing and might leave us a bit sore. Yet, as we age, falling down becomes an extension of a chronic condition, over-medication, or visual and physical limitations, and the consequences of a fall can be severe.
The reality of being older and falling can be seen in nursing homes and rehabilitation facilities with elders facing broken hips and bones and bearing the difficult burden of extensive, debilitating rehabilitation. And for those of us aging with a disability, a fall is very serious business. I am a polio survivor, having contracted this disease at a young age, and have spent my life with assistive devices (e.g., Canadian crutches and braces). Thus, in some ways I’ve had a lifetime to prepare for and perfect methods and behavioral changes to lessen the risk of falling. I’ve not always been successful; some years back I fell and fractured a femur. Through excellent orthopedic medical intervention and PT/OT (physical and occupational therapy), I have since done quite well and avoided falls and injuries. It has required, however, a methodical, systematic, comprehensive and behavioral adaptation. This includes a high degree of self-awareness and pursuing the adaptations that lessen the likelihood and severity of a fall.
Most individuals, as they become more frail, weak or debilitated, find it hard to accept the reality that they are no longer as mobile and physically active as before. Thus, the inability to accept these realities increases the chances that a fall will occur. The proverbial “furniture walking” of an older adult who refuses to use a walker, cane, wheelchair or assistive device is a good example. Counseling and personal therapy are, in my view, a precondition to understanding and accepting the modifications that can lessen the possibility of a fall.
The next set of preparation involves the personal space, usually the home. Ideally, hiring a consultant/expert who understands home modifications is best. I, myself, have used the expertise of the USC Gerontology Center for Falls Prevention (Dr. Jon Pynoos) to come to my home and do an extensive assessment of my personal condition and its correlation with what changes to my living space will lessen falls. This assessment led to a complete revamping of the bathrooms, kitchen, doorways, lighting, floors, colors and furniture. The modifications were based on my physical limitations and abilities and they have paid off: to this day, my wife knows I am safe when at home.
Falls prevention also requires a recognition of one’s own personal stamina, use of medication, fatigue level, and cognitive, visual and hearing abilities. To this end, UCLA has been most attentive. As required by the Americans with Disabilities Act, the university provides me accessible parking and an office that gives me safety and security, while arranging that my class be conducted indoors to avoid inclement weather. These are examples of thinking ahead and being proactive.
Promoting universal design is the single biggest and most important role for government. It is time for our society to prepare for the aging of the 78 million Baby Boomers and the extended life span accruing to those of us with early onset disabilities. Real estate (residential and commercial) developers and builders can incorporate the basic features of accessibility – grab bars, a bedroom on the ground floor, ramps (for potential use of wheelchairs) – in ways that are both affordable and appealing and enable individuals to age in place regardless of their physical and cognitive abilities. Taking these steps will, in turn, lessen the prevalence of falls.
Falls, however, can never be fully avoided, but mitigated. The role of physical and occupational therapy and rehabilitation facilities is crucial and the potential for technology (e.g., sensors to detect a fall) can lessen the severity and time of recovery. Herein lies one question: Why does it appear that women, more than men, are better able to benefit from rehabilitation and recover more quickly? I leave the answer to others but conclude with the advice that all of us will one day face a fall, but by accepting the reality of our changing conditions and being proactive about planning ahead, we can mitigate the consequences and hasten the moment of recovery.
Fernando Torres-Gil is the Director of the Center for Policy Research on Aging at UCLA.
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